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Low-income homebound older adults receiving home-delivered meals: Physical and mental health conditions, incidence of falls and hospitalisations

Namkee G Choi, John E Sullivan, C Nathan Marti
Health & Social Care in the Community 2019 March 20
Significant differences in health across racial/ethnic and socioeconomic groups in the US signal increasing numbers of low-income homebound older adults in a rapidly ageing society. The purpose of this study was to examine physical and psychiatric conditions and their association with incidence of self-reported falls and hospitalisations among largely low-income and racial/ethnic minority adults age 50+ (N = 2,224), clients from a home-delivered meals programme in Central Texas. Data came from comprehensive, in-home assessments done in 2017 by these older adults' case managers. We used bivariate analyses to compare those with and without incidence of self-reported past-year falls and those with and without a hospitalisation episode with respect to their sociodemographic and clinical characteristics. We used multivariable logistic regression analysis to examine sociodemographic and clinical correlates of any incidence of falls and negative binomial regression analysis to examine these correlates of the number of hospitalisations in the preceding 12 months. The rates of chronic physical illnesses, including cardiovascular disease, diabetes, gastrointestinal disease, lung disease and renal failure, were extremely high. The 41% of reported falls among the study sample was also higher than the rate among US older adults in general. More diagnosed physical illnesses, depression, chewing/swallowing problems, chronic/severe pain, activities and instrumental activities of daily living (ADL/IADL) impairments and ambulation assistive device use were associated with greater odds of falling. The rate of past-year hospitalisation was 26%, and more diagnosed physical illnesses, ADL/IADL impairments, ambulation assistive device use and any fall incidence were positively associated with the number of hospitalisations. These findings indicate the need for fall prevention programmes for frail homebound older adults as well as health and social care services that help older adults better manage physical/mental health problems and reduce preventable health crises and hospitalisations.


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